Early and long-term results of hypothermic circulatory arrest in aortic surgery: a 20-year single-centre experience.
J Cardiovasc Med (Hagerstown)
; 22(7): 572-578, 2021 07 01.
Article
em En
| MEDLINE
| ID: mdl-33534299
ABSTRACT
AIMS:
The aim of this study was to document the postoperative outcomes of patients who underwent hypothermic circulatory arrest (HCA), the evolution of HCA management over time and to identify the risks factor for early mortality and postoperative stroke.METHODS:
Four hundred and twenty-four patients who underwent aortic surgery with HCA at our institution between January 1995 and June 2016 were consecutively included.RESULTS:
The main indications were degenerative aneurysm (254; 59.9%) and acute type A aortic dissection (146; 34.4%). Interventions were performed under deep (18.4â±â0.9°C; nâ=â350; 82.5%) or moderate (23.9â±â1.9°C; nâ=â74; 17.5%) hypothermia. Antegrade cerebral perfusion (ACP) was employed in 86 (20.3%) cases. The use of moderate hypothermia significantly increased from 2011, to become the preferred strategy in 2016. The in-hospital mortality was 12.5% and the postoperative stroke rate was 7.1%. Kaplan--Meier 5-year survival was 65.7%. Nonelective timing [odds ratio (OR) 4.05; Pâ<â0.001], stroke (OR 3.77' Pâ=â0.032), renal failure (OR 2.49; Pâ=â0.023), redo surgery (2.42; Pâ=â0.049) and CPB time (OR 1.05; Pâ=â0.03) were independent risk factors for in-hospital mortality in multivariate analysis. Femoral cannulation was the only independent risk factor for stroke (OR 3.97; Pâ=â0.002). The level of hypothermia and the use of ACP were not associated with either in-hospital mortality or postoperative stroke.CONCLUSION:
HCA might be widely considered to achieve a radical treatment of the aortic disease, provided that hypothermia is maintained below the 24°C safety threshold and ACP is used for HCA exceeding 30âmin, to ensure optimal brain, spinal cord and visceral organs protection.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Aneurisma Aórtico
/
Complicações Pós-Operatórias
/
Implante de Prótese Vascular
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Acidente Vascular Cerebral
/
Parada Circulatória Induzida por Hipotermia Profunda
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Dissecção Aórtica
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
País/Região como assunto:
Europa
Idioma:
En
Revista:
J Cardiovasc Med (Hagerstown)
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
Ano de publicação:
2021
Tipo de documento:
Article